Question
QUESTION: I have had bursitis in my left foot between the third and fourth metatarsal bones for a few months now and even though I have had 2 cortisone injections it is still painful and can't bear weight.I have been resting as much as possible but my pain isn't improving. Due to my altered walking I have developed the same symptoms in the right foot. The doctor has not deemed it necessary to inject my right foot with cortisone but I also can't bear weight on this foot without pain and it is not improving.  I have been referred to an orthopedic surgeon from my GP and podiatrist. My questions are:

1. How successful is removing a metatarsal bursa? I read a journal article entitled '50 cases of bursitis of the foot' in the Journal of Bone and Joint Surgery but there was no long term follow up. Do you think most surgery's to remove a painful metatarsal bursa work or not?
2. Do healthy metatrsal bursas grow back usually?
3. Is it common for the bursitis to return after surgery? If yes what should I do to aviod this?
4. After how many months rest would you deem surgery appropriate?
5. Do you think I will be able to run and play sports again?
6. Any advice or tips?

THANK YOU VERY MUCH FOR YOUR TIME.

ANSWER: This Chicago, South Loop & Elmhurst Podiatrist of AnklenfootCenters.com says.......

Dear Leif,
Have you tried orthotics?
Are you overweight?
Please see our website at AnklenFoot.com. On the foot under ball of foot and click-read metatarsalgia for additional information regarding your condition. Also read under plantarflexed metatarsal and capsulitis of the foot. These sections will cover most if not all aspects of your painful foot condition.
The bursa sacs are only removed if the patient has a rheumatoid type disorder.You did not mention if you had it.
If the 3rd & 4th metatarsals are longer then the removal of the bursa sacs will not work
If you are overweight-lose weight-lot cheaper and safer than surgery.
Make sure you stretch your Achilles tendons-which should put less weight on your bursa sacs
I do not advise removing the bursa sacs of the foot! Try custom orthotics/orthoses and a good bio-mechanical exam-Seek a Board Certified Podiatrist-worth the drive.
Good treatment by someone knowledgeable should allow you to return to sports.
Hope This Helps
Good Luck!

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.

---------- FOLLOW-UP ----------

QUESTION: Thanks for your advice. I am not overweight and yes I have tried orthotics. I even had a tailor made pair from the podiatrist but I can't wear them because I can't put weight on the front part of my foot at all. If I do it become very sore and swollen. The only shoes I can wear are sports sandals with rocker bars on the bottom so no pressure is put on the forefoot. I have read everything I can find on metatarsaligna but all of the conservative measures havent worked and its been months. I am in Australia and it takes some time to get to see an orthopedic surgeon who can perform a MRI scan to see whats going on. I have seen 2 podiatrists who couldnt help me. I will stretch my achellies as advised and seek a podiatrist who performs bio-mechanical exams. Unfortunately my symptoms seem to be worse than is common.

Thanks very much for your reply.

ANSWER: This Chicago, South Loop & Elmhurst Podiatrist says.......

Dear Leif,

I understand your frustration-but I am pretty sure you have metatarsalgia that is causing the bursitis.You need to go back to the podiatrist who made the orthotics and tell them that they are making the symptoms worse and you expect at the very least an adjustment or even a redo. The orthotics should have large metatarsal pads/bars and pockets for the inflamed joints-Be prepared to go a shoe size larger to accommodate the orthotics. Unfortunately some podiatrists in Australia are not allowed to do the things we do for our patients in the US. Did anyone discuss your metatarsal parabola? Was an axial sesamoid view taken.
These are simple x-rays to help with your diagnosis. IF they can't take the x-rays or don't know what I'm talking about-don't go there. Remember what I said-unless the bursa sacs in the foot have pathology(they are diseased)-do not remove them.
Perhaps draining them may help-only let someone who understands the above do the procedure.
In the meantime wear the rocker bars constantly and take the maximum dose of Alleve for a few days-as long as your stomach doesn't bother you. If you don't aggravate it-it will quiet down  
in 4-6 weeks

Hope This Helps

PS-You go to docs who can't help you or don't have a clue and you give me a lukewarm rating-Because I know the answer?
Think of being polite next time.-I was not going to answer-but I felt bad for you. Did your other docs do that for you? My advice was the best and free!!!
Because of ratings like yours I will no longer accept ratings.

Good Luck Again!

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your reply. I really appreciate it. I understand what you are saying that the metatarsaligna is causing the bursitis and yes I have seen several health professions who have not helped me at all. This does leave me wondering though - how can I fix the metatarsaligna? or is it only possible to know this after having the x rays you mentioned? I may need surgery to fix the metatarsaligna? I have been resting and keeping off my feet for about two months now and the inflamation has decreased but as soon as I put weight on my feet it swells up again and even with no walking it is quite painful. So I should:
1. See another podiatrist and get new innersoles?  
2. Have new x rays?
3. Then what?


Do you think I will always have to wear orthotics in the future? Do you think I will be able to run again?

Thanks so much I really do appreciate it as this has really affected my life this year. Sorry for my first rating. I wasnt being rude it was my honest rating. Your last response was great and I rated it a perfect 10.

Thanks again.

Answer
This Chicago, South Loop & Elmhurst Podiatrist of AnklenfootCenter.com says.......


Dear Leif,

Go back to the doctor who made the orthotics and insist that he/she redo them to offload the inflamed bursa. This can be done my applying metatarsal pads or "bars" just behind the irritated area and also making "pockets" in the orthotic for the metatarsal heads that are above the bursa.
Be ready to go a 1/2 size bigger in your shoes to accommodate the orthotics.  
If they don't quiet down in a month then seek a consult from a podiatrist who understands what a plantarflexed (lower) metatarsal is.
Look at your hand and  knuckles from the top with you fist clenched like a punch. You will notice that the 3rd knuckle is protruding. Imagine walking gorilla style on your knuckles.The 3rd knuckle will get irritated and stay irritated everytime you walk on your knuckles. You can wear a glove with a pocket for the 3rd knuckle(like an orthotic),or if that does not work you shorten the 3rd bone , which will put the 3rd knuckle even with the 2nd & 4th knuckles. Now the pressure will be reduced greatly.
The procedure is called osteotomy of the metatarsal in the foot. It is surgery-but recovery is relatively fast(5-6 weeks) and not a very painful procedure-if done by someone who has done a lot of them.
The new smart podiatrist will figure out if you need additional x-rays and if the surgery will really help.
Don't let any of the first doctors who you saw treat you with surgery!
 

Hope This Helps
Good Luck!

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.